title: Synovial sarcoma of the spine: A report of three cases and review of the literature.
abstract: BACKGROUND
  Synovial sarcoma (SS) is a rare sarcoma with distinct morphologic and genetic features, which, despite its name, does not arise from synovium. While most SSs (>80%) arise in the deep soft tissue of the extremities, up to 5% of these tumors are encountered in the body axis including the spine, mediastinum, retroperitoneum, and head/neck regions. Reports of SS located within the spinal axis have been rare to date.
  
  
  METHODS
  We searched the medical records at our institution and found three patients who were diagnosed and treated for SSs involving the spine. We also performed an exhaustive literature search using PubMed to identify all reported cases in the literature.
  
  
  RESULTS
  In this study, we report on three SS cases involving the spine. All three cases involved the paraspinal muscles and spinal nerve roots, with one case having a significant leptomeningeal involvement. In two cases, "smaller operations" were performed first because the lesions were thought to be benign, however, when the final pathology identified them as SSs, more radical procedures were performed. Additionally, we identified 14 cases of SSs involving the spine published in the literature and all cases are reviewed here.
  
  
  CONCLUSIONS
  Due to limited numbers of cases, spine SS long-term outcomes are hard to quantify. The currently accepted standard of treatment for SSs starts with wide surgical excision with negative margins followed by chemotherapy and radiation. We summarize the available literature on spinal SSs and review the current treatment options available for these tumors.
authors.affiliation: Mayo Clinic, 200 1 St SW Rochester, MN 55905, Mayo Medical School, MN 55905, USA.
authors.forename: Ross C
authors.initials: RC
authors.lastname: Puffer
authors.forename: David J
authors.initials: DJ
authors.lastname: Daniels
authors.forename: Caterina
authors.initials: C
authors.lastname: Giannini
authors.forename: Mark A
authors.initials: MA
authors.lastname: Pichelmann
authors.forename: Peter S
authors.initials: PS
authors.lastname: Rose
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Clarke